By K. Barrack. University of Louisville. 2018.

Vancomycin is the drug of choice for serious infections due to methicillin-re- sistant S generic 200 mg pyridium free shipping. Vancomycin is typi- cally used intravenously purchase pyridium 200 mg without a prescription, although orally available cheap pyridium 200 mg without prescription, and does not provide adequate coverage for bowel sterilization discount 200mg pyridium otc. Although orally available cheap pyridium 200 mg with mastercard, erythromycin, nitrofurantoin, and ciprofloxacin also do not have adequate coverage. Doxycycline, a tetracycline (30S ribosome inhibitor), is the antibiotic of choice to treat Rocky Mountain spotted fever, a rickettsial disease. Ciprofloxacin can be used to treat an- thrax, and erythromycin is the most effective drug for the treatment of Legionnaires disease. Steven-Johnson syndrome is a form of erythema multiforme, rarely associated with sulfonamide use. Patients with glucose-6-phosphate dehydrogenase deficiency are at risk of developing hemolytic anemia. The antibiotic classes that inhibit the 30S ribosome include amino- glycosides and tetracycline. Inhibitors of the 50S ribosome include chloramphenicol, erythromycin, and clindamycin. Bacterial cell wall inhibitors include penicillins, cephalosporins, and vancomycin. Often rifampin, ethambutol, streptomycin, isonia- zid, and pyrazinamide are used for months together, as many strains are multidrug resistant. Patients with increased risk of Neisseria meningitides infection can be given rifampin for prophylaxis. Amphotericin is used in the treatment of severe disseminated candidiasis, sometimes in conjunction with flucytosine. It is often toxic and causes fevers and chills on infu- sion, the ‘‘shake and bake. Cycloserine is an alternative drug used for mycobacterial infections and is both nephrotoxic and causes seizures. Mefloquine is the primary agent used for prophylaxis in chloroquine-resistant areas. Doxycycline is used with quinine for acute malarial attacks due to multiresistant strains. Metronidazole is used to treat protozoal infections due to Giardia, Entamoeba, and Trichomonas spp. Mebendazole is used to treat round worm infections, and thiabendazole is used to treat Strongyloides infection. Ivermectin is used to treat filariasis, whereas praziquantel is used to treat schistosomiasis. Niclosamide can be used to treat tapeworm infections, and pyrantel pamoate is used to treat many helminth infections. Valacyclovir is related to acyclovir, both of which are used for the treatment of oral and genital herpes in immunocompetent individuals. Vidarabine is used in more severe infections in neonates as well as in the treatment of zoster. Because cancer may potentially arise from a single malignant cell, the therapeutic goal of can- cer chemotherapy may require total tumor cell kill, which is the elimination of all neoplastic cells. Early treatment is critical because the greater the tumor burden, the more difficult it is to treat the disease. A therapeutic effect is usually achieved by killing actively growing cells, which are most sensitive to this class of agents. Because normal cells and cancer cells have similar sensitivity to chemotherapeutic agents, adverse effects are mostly seen in normally dividing nonneo- plastic cells, such as bone marrow stem cells, gastric and intestinal mucosa, and hair follicles. Achievement of the therapeutic effect may involve the use of drugs, sometimes sequentially, that act only at specific stages in the cell cycle (e. Primary resistance is seen in tumor cells that do not respond to initial therapy using cur- rently available drugs. The probability that any tu- mor population has primary resistance to two non–cross-resistant drugs is even less likely (approximately the product of the two individual probabilities). In this case, cells overproduce cell surface glycoproteins (P-glycoproteins) that actively transport bulky, natural product agents out of cells (Table 12-1).

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For the rest purchase 200 mg pyridium amex, the subject was largely neglected: the majority of classicists considered it too medical and too technical purchase 200mg pyridium visa, while the fact that the main texts were in Latin and Greek (and often in a quite technical generic 200 mg pyridium otc, austere kind of Latin and Greek at that) did not help to secure the subject a prominent place in the attention of medical historians or members of the medical profession at large order pyridium 200mg visa. Nothing could be further from my intention than to dismiss the con- tribution of members of the medical profession to the study of ancient medicine – indeed pyridium 200mg visa, I myself have often benefited from the collaboration and dialogue with medically trained colleagues when studying ancient Greek medical texts. Still, it is fair to say that, especially in the first half of the twen- tieth century, the interest taken by medical people in Greek and Roman medicine was often motivated, apart from antiquarian intellectual curiosity, by what we could call a positivist, or presentist, attitude. There often was an underlying tendency to look for those respects in which Greek medicine was, as it were, ‘on the right track’, and to measure the extent to which the Greeks ‘already knew’ or ‘did not yet know’ certain things which contempo- rary biomedicine now knows, or claims to know, to be true. In other words, it was inspired by 3 A striking example is the vigorous debate initiated by R. Kapferer in the 1930s on the question whether the Hippocratic writers were familiar with the process of blood circulation; for a review of this debate see Duminil (1998) 169–74. Postmodernism, pluralism, cultural relativism and comparativism, as in so many other areas, have had their impact also on the study of Greek medicine and science. Questions have been asked about the uniqueness of Greek medical thought, and it has been suggested that its debt to earlier, Near Eastern and Egyptian thinking may have been much greater than was commonly assumed. Questions have also been raised about the rationality of Greek medical thought, about the assumption that Greek medicine developed ‘from myth to reason’,4 and Greek medicine has been shown to have been much more open and receptive to superstition, folklore, religion and magic than was generally believed. Furthermore, in the academic study of medical history – and to a certain extent also in the historiography of science – significant changes have oc- curred over the past decades, especially in the area of medical anthropology, the social, cultural and institutional history of medicine and science, the history of medical ethics, deontology and value systems, and the linguistic study and ‘discourse analysis’ of medical texts. There has been an increasing realisation of the social and cultural situatedness of medicine, healthcare and knowledge systems: individuals, groups of individuals and societies at large understand and respond differently to the perennial phenomena of sickness and suffering, health and disease, pain and death; and these reac- tions are reflected in different medical ideas, different ‘healthcare systems’, different value systems, each of which has its own social, economic and cultural ramifications. This appreciation of the variety of healthcare (and knowledge) systems – and indeed of the variety within one system – is no doubt related to the increasing acceptance of ‘alternative’ or ‘comple- mentary’ medicine in the Western world and the corresponding changes in medical practice, doctor–patient relationship and the public perception of the medical profession. And the traditional assumption of a superiority of Western, scientific medicine over non-Western, ‘primitive’, ‘folklore’ or ‘al- ternative’ medicine has virtually reached the state of political incorrectness. This shift in attitude has had rather paradoxical implications for the study of ancient medicine. In short, one could say that attention has widened from texts to contexts, and from ‘intellectual history’ to the history of ‘dis- courses’ – beliefs, attitudes, perceptions, expectations, practices and rituals, their underlying sets of norms and values, and their social and cultural ramifications. At the same time, the need to perceive continuity between 4 For a more extended discussion of this development see the Introduction to Horstmanshoff and Stol (2004). Introduction 5 Greek medicine and our contemporary biomedical paradigm has given way to a more historicising approach that primarily seeks to understand med- ical ideas and practices as products of culture during a particular period in time and place. As a result, there has been a greater appreciation of the diversity of Greek medicine, even within what used to be perceived as ‘Hippocratic medicine’. For example, when it comes to the alleged ‘ratio- nality’ of Greek medicine and its attitude to the supernatural, there has first of all been a greater awareness of the fact that much more went on in Greece under the aegis of ‘healing’ than just the elite intellectualist writing of doctors such as Hippocrates, Diocles and Galen. Thus, as I argue in chapter 1 of this volume, the author of On the Sacred Disease, in his criticism of magic, focuses on a rather narrowly defined group rather than on religious healing as such, and his insistence on what he regards as a truly pious way of approaching the gods suggests that he does not intend to do away with any divine intervention; and the author of the Hippocratic work On Regimen even positively advocates prayer to specific gods in combination with dietetic measures for the prevention of disease. Questions have further been asked about the historical context and representativeness of the Hippocratic Oath and about the extent to which Hippocratic deontology was driven by considerations of status and reputa- tion rather than moral integrity. And the belief in the superiority of Greek medicine, its perceived greater relevance to modern medical science – not to mention its perceived greater efficacy – compared with other traditional healthcare systems such as Chinese or Indian medicine, has come under attack. As a result, at many history of medicine departments in universi- ties in Europe and the United States, it is considered naıve¨ and a relic of old-fashioned Hellenocentrism to start a course in the history of medicine with Hippocrates. This change of attitude could, perhaps with some exaggeration, be described in terms of a move from ‘appropriation’ to ‘alienation’. Greek, in particular Hippocratic medicine, is no longer the reassuring mirror in which we can recognise the principles of our own ideas and experiences of health and sickness and the body: it no longer provides the context with which we can identify ourselves. Nevertheless, this alienation has brought about a very interesting, healthy change in approach to Greek and Roman medicine, a change that has made the subject much more interesting and 5 For an example see the case study into experiences of health and disease by ‘ordinary people’ in second- and third-century ce Lydia and Phrygia by Chaniotis (1995). An almost exclusive focus on medical ideas and theories has given way to a consideration of the relation between medical ‘science’ and its environment – be it social, political, economic, or cultural and religious. Indeed ‘science’ itself is now understood as just one of a variety of human cultural expressions, and the distinction between ‘science’ and ‘pseudo-science’ has been abandoned as historically unfruitful. And medicine – or ‘healing’, or ‘attitudes and ac- tions with regard to health and sickness’, or whatever name one prefers in order to define the subject – is no longer regarded as the intellectual property of a small elite of Greek doctors and scientists. There is now a much wider definition of what ‘ancient medicine’ actually involves, partly inspired by the social and cultural history of medicine, the study of medical anthropology and the study of healthcare systems in a variety of cultures and societies. The focus of medical history is on the question of how a soci- ety and its individuals respond to pathological phenomena such as disease, pain, death, how it ‘constructs’ these phenomena and how it contextualises them, what it recognises as pathological in the first place, what it labels as a disease or aberration, as an epidemic disease, as mental illness, and so on.

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